MEDICARE: LYNNHAVEN FOOT AND ANKLE CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	0103300951	VA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	0103300951	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5936440001	OTHER	VA	MEDICARE DMEPOS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881746642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNNHAVEN FOOT AND ANKLE CENTER, INC.

Provider Business Mailing Address
First Line	:	1547 AMBERLEY FOREST RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-4706
Country	:	US
Telephone Number	:	757-963-6363
Fax Number	:	757-363-3453

Provider Business Practice Location Address
First Line	:	1547 AMBERLEY FOREST RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-4706
Country	:	US
Telephone Number	:	757-963-6363
Fax Number	:	757-363-3453

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTHONY J. VUOLO JR.
Credential	:	DPM
Telephone Number	:	757-963-6363

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	02/26/2008

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Directions to “LYNNHAVEN FOOT AND ANKLE CENTER, INC. ” Practice Location

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